Enama for constipation: Everything You Need to Know
Everything You Need to Know
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Enemas are used to relieve constipation and cleanse the colon. Water- or saline-based enemas tend to carry the least risk. However, enemas can have side effects, such as disturbing your gut bacteria and affecting your body’s electrolyte balance.
Enemas are rectal injections of fluid intended to cleanse or stimulate the emptying of your bowel.
They have been used for hundreds of years to treat chronic constipation and prepare people for certain medical tests and surgeries (1).
Enemas can be administered by a medical professional or self-administered at home.
This article reviews different types of enemas, as well as their potential benefits and health concerns.
Constipation is a condition in which the natural movement of your stool slows down, making them hard, dry, and difficult to excrete. For many people, this can be a chronic problem that requires an intervention like an enema — or a laxative inserted rectally.
Enemas may also be prescribed to flush out your colon before certain diagnostic tests or surgeries. Your bowel needs to be empty before these procedures to reduce infection risk and prevent stool from getting in the way.
According to some enema advocates, when waste builds up in your colon over time, it leads to ailments like depression, fatigue, headaches, allergies, and irritability, and using enemas can provide relief.
While it’s true that many people with chronic constipation experience depression and other psychological symptoms, evidence is lacking to suggest that waste buildup directly leads to the other aforementioned effects (2, 3).
There are two main types of enemas — cleansing and retention.
Cleansing enemas are water-based and meant to be held in the rectum for a short time to flush your colon. Once injected, they’re retained for a few minutes until your body rids itself of the fluid, along with loose matter and impacted stool in your bowel.
Some of the most common cleansing enemas include (3, 4):
- Water or saline. The least irritating of all options, water or saline — salt water that mimics your body’s sodium concentration — are used primarily for their ability to expand the colon and mechanically promote defecation.
- Epsom salt. This is similar to a water or saline enema, but magnesium-rich Epsom salt is said to be more effective at relaxing bowel muscles and relieving constipation.
- Sodium phosphate. This is a common over-the-counter enema that works by irritating your rectum, causing it to expand and release waste.
- Lemon juice. Lemon juice mixed with warm, filtered water is said to balance the pH of your body while cleansing your colon.
- Apple cider vinegar. Advocates say that mixing apple cider vinegar with warm, filtered water can quickly clear the bowel and may have other antiviral healing effects on your digestive system.
- Soap suds. Adding castile soap, or another mild soap with minimal additives, to water mildly irritates the bowel, which encourages the rapid excretion of stool.
Retention enemas are designed to be held in your bowel for an extended period — usually a minimum of 15 minutes — before being released. Retention enemas may be water- or oil-based, which softens the stool and makes it easier for your body to expel.
Some of the most common retention enemas include (5, 6, 7):
- Coffee. Coffee enemas are a mixture of brewed, caffeinated coffee and water thought to promote bile removal from the colon. They were popularized by Max Gerson, a physician who used them to help treat people with cancer.
- Mineral oil. This type of enema works primarily by lubricating waste inside of your colon, sealing it with water, and promoting its removal.
- Probiotic. Mixing probiotics with water may cleanse your bowel while helping colonize your good gut bacteria. Lactobacillus reuteri enemas have been shown to reduce inflammation in children with ulcerative colitis.
- Herbal. Some people use herbs like garlic, catnip tea, or red raspberry leaf mixed with water to make herbal enemas with purported nutritional, infection-fighting, and anti-inflammatory benefits.
Enemas are rectal injections of fluid that are intended to cleanse your bowel or treat chronic constipation. The two main types — cleansing and retention enemas — come in a variety of solutions and can be injected at home.
Enemas can treat constipation and clear out your bowel. However, many people choose to use enemas for other purported health benefits (8, 9).
Some advocates claim that enemas can support weight loss, remove toxins and heavy metals from your body, and improve your skin, immunity, blood pressure, and energy levels.
Still, evidence is limited to suggest that enemas are effective for these purposes or that they benefit everyone who uses them. Most evidence in support of their effectiveness is anecdotal, despite their widespread use in modern medicine (10).
Enemas appear to be most effective when used to relieve chronic constipation in a medical setting, though they come with many risks, especially when self-administered at home (11, 12).
Enemas can be effective in cleansing the bowel and treating chronic constipation, but most evidence in their favor is anecdotal rather than science based.
Though enemas can clean out your bowel, you should consider their risks and take certain precautions before using one.
May interrupt your body’s natural balances
Enemas may disturb your gut bacteria and throw off your body’s electrolyte balance.
Research shows that enemas used in preparation for medical procedures significantly disrupt gut bacteria, though the effect appears to be temporary. However, enemas that are split and administered in two doses seem to have fewer effects on the microbiome (13, 14).
Electrolyte disturbances have been observed with various types of enemas, such as large-volume soap suds enemas and those containing minerals.
For instance, there have been reports of Epsom salt enemas causing death from magnesium overdose. In another case, an older man died from severe electrolyte disruption caused by taking two sodium phosphate enemas (3, 15, 16).
Other reports note that the overuse of enemas to flush out the colon may lead to severe dehydration, which can be fatal (17).
Enema solutions can harm your bowel
Lemon juice, apple cider vinegar, and coffee enemas are highly acidic, and scientific evidence to suggest their effectiveness or safety is lacking.
What’s more, the evidence shows that their acidity and makeup can harm your bowel and lead to rectal burns, inflammation, infections, and even death (1).
Similarly, there are reports of children being given acidic hydrogen peroxide enemas, which resulted in an inflamed colon, bloody diarrhea, vomiting, and long-term complications (18).
Furthermore, in some people, herbal enemas have caused internal bleeding that required a blood transfusion and removal of the colon (1).
Dirty or improperly used tools can cause infection and damage
If you self-administer an enema at home, it’s critical to make sure that the tools you use are sterile, meaning they’re free of harmful germs. The use of dirty tools increases your risk of contracting a potentially dangerous infection.
Improper tool use may also cause physical damage to your rectum, anus, or colon. Studies indicate that perforation of the bowel is not a rare complication of frequent enema use that could put your internal organs at risk of infection (3, 12, 19).
Sterile enema injection kits, which usually include a bucket, tubing, solution, and sometimes a bulb, can be found online or at many local drug stores. They come with directions for cleaning and safe use.
Though enemas can be safe and effective, they come with many risks, especially when administered at home. Improperly used enemas can cause potentially life-threatening physical and chemical damage to your rectum or colon.
If you’re mainly considering an enema to stimulate and clean out your digestive system, there may be other, less invasive options.
Some potential alternatives to enemas, which can promote waste excretion and bowel regularity, include (20, 21, 22, 23):
- drinking caffeinated coffee, which is known to stimulate defecation
- staying well hydrated with water
- getting regular exercise like walking, running, biking, or aerobics
- trying an over-the-counter oral laxative like magnesium
- increasing your fiber intake by eating whole plant foods like fruits, vegetables, whole grains, nuts, and seeds.
If you have severe constipation or other medical issues, speak to your medical provider to determine whether an enema would be a safe and appropriate treatment.
Less risky alternatives to enemas that can help stimulate bowel movements include staying hydrated, getting regular exercise, and following a healthy, high-fiber diet.
Enemas are used to relieve constipation and cleanse the colon. Water- or oil-based solutions are injected into the bowel through your rectum to expel impacted waste.
Mild enemas like water or saline carry the least risk, but you should consult your healthcare provider before using one at home. Furthermore, ensuring the proper use of sterile injection tools is very important for safety.
Many people swear by enemas to promote regularity and prevent constipation, but evidence of their effectiveness is limited.
Other, less risky alternatives may be a better option in most cases.
Should You Use An Enema for Constipation Relief?
Having been used for thousands of years, enemas are one of the oldest methods of getting the bowels moving again if you’re suffering from constipation. Historically, the use of enemas makes sense, developing before the invention of oral and intravenous medication, notes the Canadian Society of Intestinal research.
In recent years, some celebrities have touted enemas as a way to “flush out” the digestive system and detoxify the body. However, this advice is a load of nonsense, and the regular use of enemas can actually be dangerous.
Today, better and safer treatment options, including laxatives, suppositories, and a high-fiber diet, mean enemas are typically recommended as a last resort for constipation because of possible side effects.
The Back Story: How Does an Enema Treat Constipation?
Treating constipation with an enema involves introducing fluid into the intestines via the rectum. This helps soften and break up the stool, says Bryan Curtin, MD, a gastroenterologist and director of the Center for Neurogastroenterology and GI Motility at the Melissa L. Posner Institute for Digestive Health and Liver Disease at Mercy in Baltimore.
There are several types of enemas, including tap water, sodium phosphate (such as Fleet enemas), saline, glycerin, soap suds, and mineral oils.
“While phosphorus-based enemas are traditionally considered the most potent, I find that any enema can be effective if done correctly,” Dr. Curtin says. “The oil-based enemas are fairly messy and I typically avoid those.”
How to Administer an Enema
To administer an enema, follow the instructions on the box or leaflet closely.
Bharat Pothuri, MD, a gastroenterologist at Memorial Hermann in Houston, offers the following tips for using an enema safely and effectively:
- Drink 16 ounces of water (two glasses) prior to the enema, as an enema can cause you to become dehydrated.
- Lie on your stomach with your knees pulled to your chest. If you are unable to, lie on your left side with both knees bent and your arms resting comfortably.
- Lubricate the enema tube and gently insert it into your rectum, squeezing the enema so that the contents can enter your rectum.
- Wait in that position until you feel the need to move your bowels. Try to hold the enema in for at least five minutes to achieve maximum benefit.
“It’s important to make sure you hold onto the enema until the urge to defecate is strong,” Curtin says.
Possible Side Effects of Enemas
While enemas can be a useful tool for treating severe constipation, they do come with some risks and are not meant for frequent use.
“Like any other medication, enemas can be abused,” Curtin says. “Too much enema use can lead to anorectal pain disorders. Generally, you should avoid using enemas regularly unless instructed to by your doctor.”
Enemas that are administered incorrectly can damage the tissue in the large intestine and cause bowel perforation, research such as a case report published in 2020 in SAGE Open, has shown. If an enema is not sterile, it can put you at risk of an infection, including sepsis, Dr. Pothuri notes.
One study notes that perforation, hyperphosphatemia (a condition characterized by too much phosphate in the blood), and sepsis following enema use may cause death in up to 4 percent of cases.
Long-term use of enemas can lead to electrolyte imbalances, which can cause uncomfortable symptoms like fatigue, headache, muscle cramping, nausea and vomiting, per the Cleveland Clinic.
People with colorectal cancer, an enlarged distended colon which may be more prone to perforation, and people who have active inflammatory bowel disease should avoid using enemas, Pothuri says.
If you have any questions about the safety of enemas, talk to your doctor. It’s best to consult your healthcare provider before using an enema and to exhaust all other ways of treating constipation first.
Safer Options for Constipation Relief
Because of the possible side effects of enemas, it’s usually only advised as a last-resort option to treat constipation.
Before considering an enema, make sure you’ve tried the following options:
High-Fiber Diet “Generally, your doctor will first start by recommending dietary changes,” Curtin says. Adding fiber to your diet increases the bulk of your stool, speeding up its passage through the digestive system. Curtin says patients who are constipated should aim for 20 to 30 grams of daily fiber. A good starting point is to add more fruits and vegetables into your diet, as well as whole grains. A sharp increase in fiber can cause bloating and gas, per the Mayo Clinic, so aim to gradually increase the amount over a few weeks. Over-the-counter supplemental fiber, such as Metamucil, is also available. Talk to your doctor to learn if this is a good option for you.
Stay hydrated. Drinking enough water is important for overall health, including digestion. “The main purpose of the colon is to reabsorb water from the stool, and if you are dehydrated more water will be taken in, leading to harder to pass stools,” Curtin says. The National Academies of Sciences, Engineering, and Medicine suggests that women get a total of about 2.7 liters (11 cups) of fluid per day and that men get about 3.7 liters (16 cups) per day. Note that not all of this fluid has to be water; it can also include nutrient-rich foods and beverages like fruit, vegetables, juice, and tea. Also, it’s important to spread out the fluids over the day. Alcohol and caffeinated drinks can cause dehydration, so you’ll want to avoid those if you’re constipated.
Laxatives Laxatives, or stool softeners, such as docusate or milk of magnesia, are available over the counter. Talk to your doctor or pharmacist if you have any questions about these medications. Overusing laxatives can lead to worsening symptoms, per the Cleveland Clinic, so you should not use the treatment for more than two weeks without talking to your healthcare provider.
Other lifestyle changes like exercise can help get things moving in your digestive tract. It’s also smart to keep a food journal so you can see which foods trigger your constipation. Certain medications and supplements may also cause constipation, so if that is a concern, talk to your doctor, who may adjust your dose or switch your prescription.
Some prescription drugs are also available to treat chronic constipation. Your healthcare provider will work with you to decide on which one is best for you. If there’s a structural problem in your colon that’s causing your constipation, your doctor might recommend surgery.
Call your doctor to talk through options if constipation is a new issue for you or you’ve been constipated for more than a few weeks.
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Enam tablets 5 mg No. 30 in Almaty
Tablets are round, white, chamfered, embossed with the inscription “EMT” on one side and “5” and with a notch on the other side (for a dosage of 5 mg )
Reddy’s Laboratories Ltd
Republic of India
Active ingredient: 9000 3
Active substance dosage:
Tablets, 5 mg
Quantity per pack:
One tablet contains
active substance 90 038 – enalapril maleate 5 mg
excipients: anhydrous lactose, maleic acid, zinc stearate
– various forms of arterial hypertension, including renovascular hypertension
– chronic heart failure (as part of combination therapy)
– hypersensitivity to enalapril, other components of the drug
– history of angioedema associated with treatment with ACE inhibitors
– pregnancy and lactation
– leukopenia and thrombocytopenia
– children and adolescents under 18 years old
– bilateral renal artery stenosis or arterial stenosis of a single kidney
– hereditary or idiopathic edema
– hereditary lactose intolerance, Lapp lactose deficiency or glucose-galactose malabsorption
Use with extreme caution in patients with autoimmune diseases, diabetes mellitus, impaired liver function, severe aortic stenosis, subaortic muscular stenosis of unknown origin, hypertrophic cardiomyopathy, fluid and salt loss. In the case of previous treatment with saluretics, in particular in patients with chronic heart failure, the risk of developing orthostatic hypotension increases, therefore, before starting treatment with enalapril, it is necessary to compensate for the loss of fluid and salts.
With the simultaneous appointment of Enam with non-steroidal anti-inflammatory drugs (NSAIDs), it is possible to reduce the hypotensive effect of enalapril; with potassium-sparing diuretics – hyperkalemia is possible; with lithium salts – slowing down the excretion of lithium.
Simultaneous use of Enam with antipyretic and analgesic drugs may reduce the effectiveness of Enam.
Enam weakens the effect of preparations containing theophylline.
Cimetidine prolongs the action of Enam.
The antihypertensive effect of enalapril is enhanced by diuretics, β-blockers.
When used simultaneously with immunosuppressants, cytostatics, the risk of developing leukopenia increases.
With the simultaneous use of potassium-sparing diuretics (including spironolactone, triamterene, amiloride), potassium preparations, salt substitutes and dietary supplements containing potassium, hyperkalemia may develop (especially in patients with impaired renal function), because ACE inhibitors reduce the content of aldosterone, which leads to a retention of potassium in the body against the background of limiting the excretion of potassium or its additional intake into the body.
With the simultaneous use of opioid analgesics and anesthetics, the antihypertensive effect of enalapril is enhanced.
With the simultaneous use of “loop” diuretics, thiazide diuretics, the antihypertensive effect is enhanced. There is a risk of developing hypokalemia. Increased risk of impaired renal function.
With simultaneous use with azathioprine, anemia may develop, which is due to inhibition of erythropoietin activity under the influence of ACE inhibitors and azathioprine.
A case of an anaphylactic reaction and myocardial infarction has been described with the use of allopurinol in a patient receiving enalapril.
Acetylsalicylic acid in high doses may reduce the antihypertensive effect of enalapril.
It has not been conclusively established whether acetylsalicylic acid reduces the therapeutic efficacy of ACE inhibitors in patients with CAD and heart failure. The nature of this interaction depends on the course of the disease.
Acetylsalicylic acid, by inhibiting COX and prostaglandin synthesis, can cause vasoconstriction, which leads to a decrease in cardiac output and worsening of the condition of patients with heart failure receiving ACE inhibitors.
With the simultaneous use of beta-blockers, methyldopa, nitrates, calcium channel blockers, hydralazine, prazosin, an increase in the antihypertensive effect is possible.
With simultaneous use with NSAIDs (including indomethacin), the antihypertensive effect of enalapril decreases, apparently due to inhibition of prostaglandin synthesis under the influence of NSAIDs (which are believed to play a role in the development of the hypotensive effect of ACE inhibitors). Increased risk of developing renal dysfunction; rarely observed hyperkalemia.
With the simultaneous use of insulin, hypoglycemic agents of sulfonylurea derivatives, hypoglycemia may develop.
With the simultaneous use of ACE inhibitors and interleukin-3, there is a risk of arterial hypotension.
When used simultaneously with clozapine, there are reports of the development of syncope.
With simultaneous use with clomipramine, an increase in the action of clomipramine and the development of toxic effects have been reported.
With simultaneous use with co-trimoxazole, cases of hyperkalemia have been described.
When used simultaneously with lithium carbonate, the concentration of lithium in the blood serum increases, which is accompanied by symptoms of lithium intoxication.
When used simultaneously with orlistat, the antihypertensive effect of enalapril decreases, which can lead to a significant increase in blood pressure, the development of a hypertensive crisis.
It is believed that the simultaneous use with procainamide may increase the risk of developing leukopenia.
When used simultaneously with enalapril, the effect of preparations containing theophylline is reduced.
There are reports of the development of acute renal failure in patients after kidney transplantation while using cyclosporine.
With simultaneous use with cimetidine, T1 / 2 of enalapril increases and its concentration in blood plasma increases.
It is believed that it is possible to reduce the effectiveness of antihypertensive agents when used simultaneously with erythropoietins.
When used simultaneously with ethanol, the risk of arterial hypotension increases.
During treatment, it is forbidden to drink alcoholic beverages, since alcohol enhances the hypotensive effect of the drug
With long-term treatment with enalapril, it is necessary to periodically monitor the picture of peripheral blood. Sudden discontinuation of enalapril does not cause a sharp increase in blood pressure.
During surgical interventions during treatment with enalapril, arterial hypotension may develop, which should be corrected by the introduction of a sufficient amount of fluid.
Enalapril should be discontinued before testing parathyroid function.
The safety and efficacy of enalapril in children have not been established.
Do not use in lactose intolerant persons.
Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous mechanisms
possible dizziness, especially after taking the initial dose of enalapril
Enam is administered orally, regardless of the meal time.
For patients not receiving diuretics – the recommended initial dose of 5 mg per day. Further, the dose is selected individually. A dose of 10 to 40 mg per day in one or two divided doses is usually required.
For patients receiving diuretics – in order to prevent hypotension, 1 – 2 days before the appointment of Enam, the diuretic should be discontinued. If it is impossible to cancel the diuretic, the recommended initial dose of Enam is 2.5 mg.
In chronic heart failure
It is better to start treatment with a dose of 2.5 mg 1 time per day. The effect of taking the drug should be expected 3-4 days. Constant monitoring of blood pressure is required. Then it is recommended to take 2.5 mg 2 times a day for 3-4 days.
Starting from the second week, the dose is increased if necessary to 10 mg 1 time per day.
At 3-4 weeks, the dose is increased to 20 mg in one or two doses if the systolic pressure is not less than 100 mm Hg. The maximum daily dose is 40 mg.
Dose selection and further treatment can be carried out on an outpatient basis, while it is necessary to assess the patient’s condition at least once a month (only when choosing a dose, a doctor’s examination and control is required every 10 days), to monitor the content of creatinine and blood electrolytes. The presence of arterial hypotension up to 80/60 mm Hg. against the background of maintenance therapy in the absence of complaints in the patient is not a reason for discontinuing the drug.
For arterial hypertension caused by nephropathy in diabetic patients
The dosage of the drug depends on whether or not diabetic nephropathy is accompanied by arterial hypertension. If diabetic nephropathy occurs against the background of normal blood pressure, then small doses of Enam are used – 2.5 or 5 mg per day. If nephropathy is accompanied by arterial hypertension, then the doses are selected in the same way as for arterial hypertension (up to a maximum of 40 mg per day).
In renal failure
For patients with creatinine clearance above 30 ml/min (blood creatinine level less than 3 ml/min), dose adjustment is not required.
If creatinine clearance is less than 30 ml/min, the recommended starting dose is not more than 2.5 mg per day.
Further dose selection is carried out individually under the control of the level of creatinine and blood electrolytes. For patients on hemodialysis, the initial dose and the dose on dialysis days should not exceed 2.5 mg per day. The duration of treatment depends on the effectiveness of therapy. With a pronounced decrease in blood pressure, the dose of Enam is gradually reduced.
Symptoms: excessive hypotension, development of myocardial infarction, acute cerebrovascular accident and thromboembolic complications against the background of a sharp decrease in blood pressure.
Treatment: intravenous administration of isotonic sodium chloride solution and, if possible, infusion of angiotensin II; removal of enalaprilat by hemodialysis is possible.
Very common (≥1/10)
– blurred vision
1/100 to <1/10):
– headache, depression
– hypotension (including orthostatic hypotension), syncope, pain
chest, arrhythmia, angina pectoris, tachycardia
– shortness of breath
– diarrhoea, abdominal pain, change in taste
– rash, hypersensitivity/angioedema of the face oh gaps and/or larynx
– hyperkalemia, increased plasma creatinine
Uncommon (≥1/1,000 to <1/100)
– anemia (including aplastic and hemolytic)
90 004 – hypoglycemia
– confusion, drowsiness, insomnia, nervousness, paresthesias,
– palpitations, myocardial infarction or cerebrovascular complications rhea, sore throat, hoarseness, bronchospasm/ asthma
– intestinal obstruction, pancreatitis, vomiting, dyspepsia, constipation,
anorexia, stomach irritation, dry mouth, peptic ulcer
– sweating, pruritus, urticaria, alopecia
– impaired renal function, renal failure, proteinuria
– convulsions, flushing, tinnitus, general malaise,
– increased plasma urea, hyponatremia 9000 5
Rarely (from ≥1/ 10,000 to <1/1,000)
– neutropenia, hypohemoglobinemia, decreased hematocrit,
– thrombocytopenia, agranulocytosis, bone marrow depression,
– pancytopenia, lymphadenopathy, autoimmune diseases
– insomnia, sleep disturbance
– Raynaud’s phenomenon
– lung infiltrates, rhinitis, allergic alveolitis/eosinophilic
– stomatitis/aphthous ulcers, glossitis
9 0004 – liver failure, hepatitis, including hepatocellular or cholestatic hepatitis, including necrosis, cholestasis, jaundice
– erythema multiforme, Stevens-Johnson syndrome, exfoliative
dermatitis, toxic epidermal necrolysis, pemphigus, erythroderma
– increased liver enzymes, increased plasma bilirubin
Very rare (<1/10,000)
– angioedema of the intestine
9000 4 Unknown (cannot be estimated from available data)
Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) (Parchon’s Syndrome)
A complex of symptoms was noted: fever, serositis, vasculitis, myalgia/myositis, arthralgia/arthritis, positive antinuclear antibody (ANA) test, accelerated ESR, eosinophilia and leukocytosis. Rash, photosensitivity and other dermatological manifestations may also occur.
If serious side effects occur, treatment should be discontinued.
10 tablets in a blister pack or 10 tablets in a blister pack made of PVC film and printed lacquered aluminum foil. 2 or 3 cell packs or 2 or 3 cell packs with tool
Store in a dry, dark place at a temperature not exceeding 25 °C.
Keep out of the reach of children!
Do not use after the expiration date.
Comparison of prices in pharmacies in Almaty
Almasat Rozybakiyeva 181a
Almasat Yemtsova 20
Gauhartas farm Sholokhova 26a
Pharmacy from Timiryazev warehouse 101
Pharmacy from warehouse Raiymbek 100
Pharmacy from warehouse Kabanbay Batyr 199a
Gauhartas farm Almaty 148
Gauhartas farm Zhansugurova 625
Gauhartas farm Kokzhiek 43a
9 0004 716 ₸
Pharmacy Pulse Gagarin 282
Pharmacy Pulse Auezov 69
Gauhartas farm Gres
Atabay Pharm ₸
Almasat Ainabulak 9а
Gauhartas farm Mailina 27
Almasat Abaya 115
Almasat Seifullina 174B
9000 4 730 ₸
Pharmacy Vale-Angel Nauryzbai Batyra 68
Gauhartas farm Ozernaya 137a
Gauhartas farm Bekmakhanov 56a
Gauhartas farm Bekesheva 82
Gauhartas farm Zholymbet 5а
Gauhartas farm Shemyakina 121
Almasat Turkebayeva 61
Almasat Auez ova 111
Gauhartas Pharmacy 2a
Pharmacy IP Kozhakhmetov Northern Ring
Almasat Makataeva 53
Saule pharm Egizbayeva 7/21
Baytursynov Med+pharm 59
Melissa Abaya 141
Melissa Maxima 900 05
From A to Z Kozhabekova 9
Melissa Aksai-4 20B
Saule pharm Zhaysan 1a/1
From A to Z Ayaz bi 2
9000 4 Melissa Dostyk 42
Melissa Khaliullina 34
Melissa Seifullina 468
A+ md. Shugyla 340a
A+ Dostyk 220
Pharmacy IP Kozhakhmetova Muratbaeva 164
765 ₸ 900 05
Pharmacy IP Kozhakhmetov Al-Farabi 63
Pharmacy IP Kozhakhmetov Aksai-3 16
Forte Pharma new Adi Sharipova 145k3
From A to Z Kazybek bi 139 k1
From A to Ya Baiterek
Pharmacy IP Zaure
Pharmacy IP Kozhakhmetov Karasai Batyr 107
790 ₸ 900 05
from A to Z Saina 12а
From A to Z Guards 7/1
Saule pharm Bekbolata 1/9
Pharmacy IP Kurennaya I.A.
From A to Z Kuldzhinsky tract 4а
From A to Z Isagulova 166 (village Irgeli)
From A to Z Mailina 13
From A to Z Malkeeva 109
KAZYNA PHARMA PLUS
Rainbow Pharmacy Ramstor
Care for each product 900 05
kz you can buy online “Enam tablets 5 mg №30” in pharmacies of Almaty at low prices.
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Enam pills 5 mg №30 price in pharmacies of Almaty
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instructions for use, price, analogues, composition, indications
Renal function assessment
Before and during the use of Enam, monitoring of renal function is necessary.
Symptomatic hypotension is rarely seen in patients with uncomplicated hypertension. Among those taking Enam, symptomatic hypotension occurs more often in patients with impaired fluid balance, for example, due to diuretic therapy, a diet with limited salt intake, diarrhea or vomiting. In such patients, it is necessary to determine the levels of electrolytes in the blood serum regularly, at regular intervals. Particular care should be taken in the treatment of patients with ischemic heart disease or cerebrovascular disease, since an excessive decrease in blood pressure can lead to myocardial infarction or stroke. Symptomatic hypotension has been observed in patients with arterial hypertension and heart failure with and without impaired renal function. This condition is more likely to occur in patients with more severe heart failure due to high-dose loop diuretics, hyponatremia, or worsening renal function. In such patients, treatment should be started under the supervision of a physician, and the patient’s condition should be closely monitored when changing the dose of Enam and / or diuretic (see section “Method of application and dosage”). Similar actions should be taken in patients with ischemic heart disease or cerebrovascular disease, since an excessive decrease in blood pressure can lead to myocardial infarction or stroke.
With the development of arterial hypotension, the patient should be placed on his back and, if necessary, administered intravenously with saline sodium chloride solution. Temporary hypotension is not a contraindication to further use of the drug. If an increase in blood pressure occurs after normalization of the circulating blood volume, therapy can be resumed at the usual doses.
In some patients with heart failure and normal or low blood pressure, an additional decrease in blood pressure may occur when using Enam. This effect is predictable and is not a reason to discontinue the drug. If hypotension becomes symptomatic, dose reduction and/or discontinuation of the diuretic and/or Enam may be required.
Impaired kidney function
Enalapril-associated renal failure has been reported, predominantly in patients with severe heart failure or underlying kidney disease, including renal artery stenosis. With timely diagnosis and appropriate treatment, renal failure associated with the use of enalapril is usually reversible.
Enam should not be administered to patients with impaired renal function (creatinine clearance <80 ml/minute) until the dose titration of enalapril reaches the dosage in this drug.
In some patients with arterial hypertension without signs of existing kidney disease, while using enalapril and a diuretic, an increase in the level of blood urea and creatinine was observed. If such a phenomenon occurs, Enam should be discontinued, and possible renal artery stenosis should be considered.
There is an increased risk of hypotension and impaired renal function if a patient with bilateral renal artery stenosis or arterial stenosis of a solitary kidney is treated with ACE inhibitors. Weakening of kidney function can occur even with mild changes in serum creatinine levels. In such patients, treatment should be started at low doses and under medical supervision, with caution increasing the dose and monitoring renal function.
There is no experience with the use of enalapril in patients with recent kidney transplantation. For this reason, treatment with enalapril is not recommended.
Aortic stenosis/hypertrophic cardiomyopathy
As with all other vasodilators, ACE inhibitors should be used with caution in patients with left ventricular valve and outflow tract obstruction. The use of such drugs should be avoided in case of cardiogenic shock and hemodynamically significant obstruction.
Rarely, the use of ACE inhibitors has been associated with a syndrome that begins with cholestatic jaundice or hepatitis and progresses to fulminant necrotizing hepatitis, sometimes fatal. The mechanism of this syndrome is not known. Patients receiving treatment with ACE inhibitors who experience jaundice or marked elevation of liver enzymes should discontinue the ACE inhibitor and establish appropriate medical supervision.
Neutropenia/agranulocytosis, thrombocytopenia and anemia have been reported in patients receiving ACE inhibitors. Neutropenia occurs rarely in patients with normal renal function and no other complicating factors.
Enalapril should be used with extreme caution in patients with collagen vascular disease, in individuals receiving treatment with immunosuppressants, allopurinol or procainamide, or a combination of these complicating factors, especially in the presence of impaired renal function. Some patients have developed serious infections that have not responded to intensive antibiotic therapy. If enalapril is prescribed to such patients, it is recommended to periodically determine the level of leukocytes, and patients should be aware of the need to inform the doctor about the occurrence of any signs of infection.
Angioedema of the face, extremities, lips, tongue, glottis and/or larynx has been reported in patients taking ACE inhibitors, including enalapril. These reactions can occur at any time during treatment. In such cases, you should immediately stop using Enam and establish appropriate monitoring of the patient’s condition to ensure the complete disappearance of symptoms before the patient is discharged. Even in cases where there is only swelling of the tongue without respiratory distress, long-term monitoring of the patient’s condition is necessary, since treatment with antihistamines and corticosteroids may not be enough.
Very rarely, fatal cases have been reported due to angioedema, which was accompanied by swelling of the larynx and tongue. Patients with swelling of the tongue, glottis, or larynx are more likely to develop airway obstruction, especially in patients with a history of airway surgery. In cases where swelling of the tongue, glottis, or larynx may lead to airway obstruction, appropriate therapy should be initiated immediately, which may include the administration of a 1:1000 solution of epinephrine (0.3-0. 5 ml) and/or measures to maintain patency respiratory tract.
The development of angioedema was more often reported in patients of the Black race who received ACE inhibitors than in patients of other races. However, it is generally believed that blacks have an increased risk of angioedema.
Patients with a history of angioedema that is not associated with the use of ACE inhibitors may have a higher risk of angioedema during the use of an ACE inhibitor. (see section “Contraindications”)
Anaphylactoid reactions during desensitization with hymenoptera venom
Life-threatening anaphylactoid reactions have rarely occurred in patients who have used ACE inhibitors during Hymenoptera. The occurrence of such reactions can be avoided by temporarily stopping the use of the ACE inhibitor before starting desensitization.
Anaphylactoid reactions during low-density lipoprotein (LDL) apheresis
Life-threatening anaphylactic reactions have rarely occurred in patients treated with ACE inhibitors during LDL apheresis with dextran sulfate. The occurrence of such reactions can be avoided by temporarily stopping the use of the ACE inhibitor before each session of apheresis.
Patients with diabetes mellitus treated with oral antidiabetic drugs or insulin, when prescribing an ACE inhibitor, it is necessary to carefully monitor for hypoglycemia, especially during the first month of combination therapy (see section “Interaction with other drugs”)
Cough has been reported with the use of ACE inhibitors. As a rule, the cough is unproductive, persistent and disappears after cessation of therapy. Cough that occurs as a result of the use of ACE inhibitors should be considered in the differential diagnosis of cough.
Enalapril blocks the formation of angiotensin II and therefore reduces the compensatory abilities of patients associated with the renin-angiotensin system during major surgical interventions or anesthesia using drugs that lead to arterial hypotension. If arterial hypertension occurs, which is explained by a similar mechanism, it can be corrected by increasing the volume of circulating blood.
In some patients receiving treatment with ACE inhibitors, including enalapril, an increase in serum potassium levels was observed.
Risk factors for developing hyperkalemia include impaired renal function, impaired renal function, age (>70 years), diabetes mellitus, intercurrent conditions such as dehydration, acute cardiac decompensation, metabolic acidosis, and concomitant use of potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene or amiloride), potassium supplements or salt substitutes containing potassium, as well as the use of other drugs associated with an increase in serum potassium levels (for example, heparin). The use of potassium supplements, potassium-sparing diuretics or salt substitutes containing potassium, in particular in patients with impaired renal function, can lead to a significant increase in serum potassium levels. Hyperkalemia can cause serious, sometimes fatal, arrhythmias. If the simultaneous use of enalapril and any of the above drugs is necessary, these drugs should be used with caution and frequently monitor the level of potassium in the blood serum (see section “Interaction with other drugs”).
As a rule, it is not recommended to use lithium in combination with enalapril and diuretics (see the section “Interaction with other drugs”).
Use by children
The safety and efficacy of the drug in children have not been established (see section “Method of application and dosage”).
As with other ACE inhibitors, enalapril is less effective in lowering blood pressure in patients of the black race compared to patients of other races. This may be due to the higher prevalence of the low-active renin system among black patients with hypertension.
Enalapril contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not use this medicine.
Double blockade of the renin-angiotensin-aldosterone system
Dual blockade of the renin-angiotensin-aldosterone system is associated with an increased risk of hypotension, hyperkalemia, and renal dysfunction (including acute renal failure) compared with monotherapy. Dual RAAS blockade with an ACE inhibitor, ARB II, or Aliskiren cannot be recommended for any patient, especially those with diabetic nephropathy.
In some cases, when the combined use of an ACE inhibitor and ARB II is absolutely indicated, careful observation by a specialist and mandatory monitoring of kidney function, water and electrolyte balance, and blood pressure are necessary. This refers to the use of candesartan or valsartan as add-on therapy to ACE inhibitors in patients with chronic heart failure. Conducting a double blockade of the RAAS under the close supervision of a specialist and mandatory monitoring of kidney function, water and electrolyte balance and blood pressure is possible in patients with chronic heart failure with intolerance to aldosterone antagonists (spironolactone), who have persistent symptoms of chronic heart failure, despite other adequate therapy (see section “Interaction with other drugs”.